Department of Family Medicine, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada
Department of Family Medicine, University of Montreal Faculty of Medicine, Montreal, Quebec, Canada.
BMJ Open. 2021 Jul 9;11(7):e045520. doi: 10.1136/bmjopen-2020-045520.
To understand identity tensions experienced by health professionals when patient partners join a quality improvement committee.
Qualitative ethnographic study based on participatory observation.
An interdisciplinary quality improvement committee of a Canadian urban academic family medicine clinic with little previous experience in patient partnership.
Two patient partners, seven health professionals (two family physicians, two residents, one pharmacist, one nurse clinician and one nurse practitioner) and three members of the administrative team.
Data collection included compiled participatory observations, logbook notes and semi-structured interviews, collected between the summer of 2017 to the summer of 2019.
Ghadiri's identity threats theoretical framework was used to analyse qualitative material and to develop conceptualising categories, using QDA Miner software (V.5.0).
All professionals with a clinical care role and patient partners (n=9) accepted to participate in the ethnographic study and semi-structured interviews (RR=100%). Transforming the 'caregiver-patient' relationship into a 'colleague-colleague' relationship generated identity upheavals among professionals. Identity tensions included competing ideals of the 'good professional', challenges to the impermeability of the patient and professional categories, the interweaving of symbols associated with one or the other of these identities, and the inner balance between the roles of caregiver and colleague.
This research provides a new perspective on understanding how working in partnership with patients transform health professionals' identity. When they are called to work with patients outside of a simple therapeutic relationship, health professionals may feel tensions between their identity as caregivers and their identity as colleague. This allows us to better understand some underlying tensions elicited by the arrival of different patient engagement initiatives (eg, professionals' resistance to working with patients, patients' status and remuneration, professionals' concerns toward patient 'representativeness'). Partnership with patients imply the construction of a new relational framework, flexible and dynamic, that takes into account this coexistence of identities.
了解当患者伙伴加入质量改进委员会时，卫生专业人员所经历的身份紧张。
基于参与式观察的定性民族志研究。
加拿大城市学术家庭医学诊所的一个跨学科质量改进委员会，几乎没有患者伙伴合作的前期经验。
两名患者伙伴，七名卫生专业人员（两名家庭医生、两名住院医师、一名药剂师、一名护士临床医生和一名护士从业者）和三名行政团队成员。
数据收集包括参与式观察、日志记录和半结构化访谈的汇编，收集于 2017 年夏季至 2019 年夏季之间。
使用 Ghadiri 的身份威胁理论框架分析定性材料，并使用 QDA Miner 软件（V.5.0）开发概念化类别。
所有具有临床护理角色和患者伙伴的专业人员（n=9）都同意参与民族志研究和半结构化访谈（RR=100%）。将“照顾者-患者”关系转变为“同事-同事”关系，引发了专业人员的身份动荡。身份紧张包括理想的“好专业人员”之间的竞争、对患者和专业人员类别不可渗透的挑战、与这些身份之一或两者相关的符号交织，以及照顾者和同事角色之间的内在平衡。
这项研究提供了一个新的视角，了解与患者合作如何改变卫生专业人员的身份。当他们被要求在单纯的治疗关系之外与患者合作时，卫生专业人员可能会感到作为照顾者和同事的身份之间的紧张。这使我们能够更好地理解不同患者参与倡议所引发的一些潜在紧张（例如，专业人员对与患者合作的抵制、患者的地位和薪酬、专业人员对患者“代表性”的担忧）。与患者合作意味着构建一个新的关系框架，灵活而动态，考虑到这种身份的共存。
